Titanium Platelet Rich Fibrin (T-PRF)
Titanium represents an extremely bioinert material with excellent hydrophilic properties. In addition, titanium is resistant to corrosion and has the property of osteointegration. Because of this feature, it has been used in dental implants as well. Little is known about the blood compatibility of metals, but we know that titanium and derivatives thereof are among the most thrombogenic materials which may explain its outstanding osteointegrating properties. The coagulation activation caused by titanium was triggered by the intrinsic pathway because the generation of FXIIa-AT/C1 esterase inhibitor paralleled that of thrombin-antithrombin, and both thrombin-antithrombin complex and FXIIa-AT/C1 esterase inhibitor generation were abrogated by corn trypsin inhibitor, which is a specific inhibitor of FXIIa. The binding of platelets was increased on the titanium surface compared to the other biomaterial surfaces and the state of platelet activation was much more pronounced as reflected by the levels of beta-thromboglobulin and PDGF. Furthermore, PDGF and other alpha-granule proteins e.g. TGF-beta, are known to be potent promotors of osteogenesis which suggests that the pronounced thrombogenic properties of titanium might contribute to the good osteointegrating properties.
Because of these properties of titanium, titanium induced platelet aggregation is better than glass. Titanium prepared platelet-rich fibrin (T-PRF) has stronger and thicker fibrin carpet than that of the glass tube prepared platelet-rich fibrin. Strong fibrin structure is important to extend the time for resorption of fibrin in-vivo, and increase the release time of growth factors. Along with the experimental studies that reveal the properties of T-PRF, many successful clinical studies have also been conducted with this second generation blood product. T-PRF has been shown to be an important alternative to connective tissue grafts in the treatment of gingival recessions. In addition, it has been used alone as a hard tissue graft material in the treatment of periodontal defects, sinus lifting applications and crest preservation techniques, by utilizing the length of in-vivo resorption time.
Successful results of T-PRF in previous clinical trials caused the birth of many new research topics. The most important one of these new research topics is relate to how the process progressed after the T-PRF was inserted into the soft and hard tissues. In particular, which is more important, the growth factors that are released more than 30 days from T-PRF, or the long resorption period of T-PRF's natural strong matrix structure, which activates bone healing mechanisms? It still be an important question. Clinical significance: Titanium-PRF tubes have therefore been developed and utilized in clinical practice. We can say that the titanium surface gives the PRF important properties by strengthening the structure of the fibrin. After T-PRF, first question to be asked is what purpose we can use platelet-rich products for: 1. For soft tissue healing? 2. As a biological material in addition to the graft material used in the hard tissue healing, for providing to faster healing rates and enhanced tissue regeneration? 3. As a biological barrier membrane in the hard tissue healing? 4. As a scaffold to the stem cells, growth factors, or other biological materials in applications? 5. As a hard tissue graft material alone? 6. Or for all these goals? Future research is ongoing.